The New Zealand medical journal · 2017
Cutaneous melanoma: an audit of management timeliness against New Zealand guidelines.
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Brian Tess, Adams Brandon, Jameson Michael
Аннотация
AIM: The New Zealand Ministry of Health's "Faster Cancer Treatment" programme aims for timely care for patients with cancer, including melanoma. Melanoma care guidelines detail investigation and treatment timeliness standards. This audit assesses compliance with these.
METHOD: Patients admitted to Waikato Hospital for melanoma surgery during the year ending February 2016 were retrospectively identified. Time intervals between care events were calculated. Demographic, lesion, surgical and histopathological characteristics were analysed.
RESULTS: For patients referred with skin lesions suspicious for melanoma, referral to first treatment (Standard 2.1), referral to diagnostic skin biopsy (Standards 2.2, 2.3), biopsy histology report to first treatment (Standard 2.4), referral to first treatment (Standards 2.2, 2.3, 2.4, 4.4) and biopsy to first treatment (Standards 2.4, 4.4) compliance was 0%, 17.6%, 21.7%, 9.3% and 21.7%, respectively. For patients referred with biopsy-confirmed melanomas, referral to first treatment (Standards 2.2, 2.4) and skin biopsy to first treatment (Standards 2.2, 2.4, 4.4) compliance was 42.2% and 42.9%, respectively.
CONCLUSIONS: Compliance was low. Attention to logistical constraints in the department reviewed may improve this. Recommendation inconsistencies within and between suspicious-lesion and confirmed-diagnosis referral pathways suggest the investigation and treatment events selected and intervals mandated by the guidelines may usefully be reconsidered.
METHOD: Patients admitted to Waikato Hospital for melanoma surgery during the year ending February 2016 were retrospectively identified. Time intervals between care events were calculated. Demographic, lesion, surgical and histopathological characteristics were analysed.
RESULTS: For patients referred with skin lesions suspicious for melanoma, referral to first treatment (Standard 2.1), referral to diagnostic skin biopsy (Standards 2.2, 2.3), biopsy histology report to first treatment (Standard 2.4), referral to first treatment (Standards 2.2, 2.3, 2.4, 4.4) and biopsy to first treatment (Standards 2.4, 4.4) compliance was 0%, 17.6%, 21.7%, 9.3% and 21.7%, respectively. For patients referred with biopsy-confirmed melanomas, referral to first treatment (Standards 2.2, 2.4) and skin biopsy to first treatment (Standards 2.2, 2.4, 4.4) compliance was 42.2% and 42.9%, respectively.
CONCLUSIONS: Compliance was low. Attention to logistical constraints in the department reviewed may improve this. Recommendation inconsistencies within and between suspicious-lesion and confirmed-diagnosis referral pathways suggest the investigation and treatment events selected and intervals mandated by the guidelines may usefully be reconsidered.